High Dose Allicin with Vitamin C Improves EPCs Migration from the Patient with Coronary Artery Disease

Endothelial Progenitor Cells (EPCs) have an important role in endothelial dysfunction repairment through neovasculogenesis and cardiac myocytes regeneration. However, EPCs migration is greatly reduced in the patient with Coronary Artery Disease (CAD). Allicin and Vitamin C are hypothesized to improve EPCs migration due to its antioxidant properties. Objective: To investigate the effect of Allicin and its combination with Vitamin C in EPCs migration of CAD patients. Material and Method: Mononuclear cells were isolated from CAD patients and cultured on fibronectin-coated plates with colony-forming unit Hill medium. The cells were divided into untreated (control), Allicin treatment (dose 100 mcg/ml, 200 mcg/ml, 400 mcg/ ml), and each dose of Allicin combined with 250 mcg/mL of Vitamin C. EPCs migration was assessed with Transwell Migration Assay Kit and evaluated by using statistical tests. Results: This research shows that EPC migration was significantly higher in the treatment. Allicin at all dose (dose 100 mcg/ml, 200 mcg/ml, 400 mcg/ml) and its combination with 250 mcg/mL of vitamin C compared to untreated group (p<0.05). Allicin increase EPCs migration in a dosedependent manner. However, the only combination of 400 mcg/ml Allicin with 250 mcg/mL of vitamin C which has significantly higher EPCs migration compared to Allicin treatment alone. Conclusion: Allicin improves EPCs migration in a dose-dependent manner. Improvement of the migration only observed on the Allicin dose 400 mcg/ml with Vitamin C

No-reflow phenomenon during percutaneous coronary intervention in a patient with polycythemia vera: A case report

Rationale: Acute myocardial infarction is the leading cause of mortality and morbidity in a patient with polycythemia vera (PV). However, the benefit of various percutaneous coronary intervention (PCI) technique on the patient with PV is relatively unexplored. Patient concern: A 46-year-old woman presented to the primary hospital complained about new-onset typical chest pain. Echocardiography examination showed inferior ST-elevation myocardial infarction (STEMIs) and increased cardiac markers. Complete blood count showed elevated hemoglobin, white blood cell, and platelet. Diagnosis: Coronary angiography revealed simultaneous total occlusion at proximal right coronary artery (RCA) and also at proximal left anterior descending (LAD) artery. Elevated hemoglobin and hematocrit with JAK2 mutation establish the diagnosis of PV. Interventions: We performed multi-vessel primary PCI by using direct stenting in RCA and aspiration thrombectomy in LAD after failed with balloon dilatation and direct stenting method. This procedure resulted in thrombolysis in myocardial infarction (TIMI)-3 flow in both coronary arteries. However, the no-reflow phenomenon occurred in the LAD, followed by ventricular fibrillation. After several attempts of resuscitation, thrombus aspiration, and low-dose intracoronary thrombolysis, the patient was returned to spontaneous circulation. The patient then received dual antiplatelet and cytoreductive therapy. Outcomes: The patient clinical condition and laboratory finding were improved, and the patient was discharged on the 7th day after PCI. Lessons: Cardiologist should be aware of the no-reflow phenomenon risk in the patient with PV and STEMI. Direct stenting, intracoronary thrombectomy, and thrombolysis are preferable instead of balloon dilatation for PCI technique in this patient

Predictive Value of Hematologic Indices in the Diagnosis of Acute Coronary Syndrome

BACKGROUND: Distinguishing between Acute Coronary Syndrom (ACS) and SCAD (Stable Coronary Artery Disease) requires advanced laboratory instrument and electrocardiogram. However, their availabilities in primary care settings in developing countries are limited. Hematologic changes usually occur in the ACS patient and might be valuable to distinguish ACS from SCAD. AIM: This study compares the hematologic indices between ACS and SCAD patients and analyses its predictive value for ACS. MATERIAL AND METHODS: A total of 191 patients (79 ACS and 112 SCAD) were enrolled in this study based on the inclusion criteria. Patient’s characteristic, hematologic indices on admission, and the final diagnosis were obtained from medical records. Statistical analyses were done using SPSS 23.0. RESULTS: In this research MCHC value (33.40 vs. 32.80 g/dL; p &lt; 0.05); WBC (11.16 vs. 7.40 x109/L; p &lt; 0.001); NLR (6.29 vs. 2.18; p &lt; 0.001); and PLR (173.88 vs 122.46; p &lt; 0.001) were significantly higher in ACS compared to SCAD patients. While MPV (6.40 vs. 10.00 fL; p &lt; 0.001) was significantly lower in ACS patients. ROC curve analysis showed MPV had the highest AUC (95%) for ACS diagnosis with an optimum cut-off point at ≤ 8.35 fL (sensitivity 93.6% and specificity 97.3%). CONCLUSION: There was a significant difference between hematologic indices between ACS and SCAD patients. MPV is the best indices to distinguish ACS

Novel CHA2DS2-VASc-HSF is Superior to CHADS2 and CHA2DS2-VASc Score to Predict the Risk of Severe Coronary Artery Disease

BACKGROUND: Various risk scoring methods are available to predict the severity of coronary artery disease (CAD). However, the majority of them are complex and require advanced technologies, thus limiting its usage in primary care settings. CHA2DS2-VASc-HSF is a novel risk scoring which we develop from CHA2DS2-VASc score. AIM: We hypothesize that CHA2DS2-VASc-HSF is predictive for the risk of severe CAD, and we compare its validity with previously established CHADS2 and CHA2DS2-VASc score. MATERIALS AND METHODS: A total of 210 patients who underwent elective coronary angiography were enrolled in our study. Anthropometric, laboratory, angiographic findings, and patient history were obtained from medical records and used to calculate CHA2DS2-VASc-HSF score. Severe CAD defined as coronary artery occlusion with the Gensini score of ≥20. Statistical analyses were done using SPSS 25.0 and MedCalc 18.2.1. RESULTS: This research showed that the patient with severe CAD has significantly higher CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HSF score compared to normal and mild CAD (p &lt; 0.001). CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HSF correlated significantly with the CAD severity (r = 0.315, p ≤ 0.001; r = 0.395, p ≤ 0.001; r = 0.612, p ≤ 0.001, respectively). CHA2DS2-VASc-HSF may predict the risk of severe CAD independent from other variables (odds ratio = 2.540; 95% confidence interval = 1.794–3.595; p = 0.002) with the cutoff value of ≥2.5 (sensitivity = 81.4% and specificity = 68.1%). Pairwise comparison of receiver operating characteristic curves showed that CHA2DS2-VASc-HSF was superior to predict severe CAD. CONCLUSIONS: CHA2DS2-VASc-HSF scores may predict the risk of severe CAD better than CHADS2 and CHA2DS2-VASc score. This score may easily be used in primary care physicians to predict the risk of severe CAD and provide an early referral to the cardiologist

Garlic Extract (Allicin) Improves the Proliferation of Endothelial Progenitor Cell (EPC) from Patients with Stable Coronary Artery Disease

BACKGROUND: The reduced number and function of endothelial progenitor cell (EPC) in stable coronary artery disease (SCAD) patients aggravate endothelial dysfunction and inhibit neovascularization, thus lead to atherosclerosis. Garlic is currently believed to increase the number and function of EPC. AIM: Therefore, this in vitro study was conducted to analyze the effect of garlic extract (allicin) on the proliferation of EPC in patients with SCAD. METHODS: Mononuclear cells were isolated from peripheral blood of eight SCAD patients and cultured on colony-forming unit (CFU)-Hill medium for 3 days. Samples were divided into two groups: Group treated with allicin and control group. The treatment group was then divided into three subgroups which received 10, 50, and 100 mg/ml of doses and incubated for 48 h. EPC proliferation was assessed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) cell proliferation assay. Immunohistochemical method of CD34+ was performed for EPC identification. Data were analyzed using independent t-test and ANOVA. RESULTS: MTT assay showed a significant increase in EPC proliferation in the allicin group compared to the control group (0.2811 ± 0.008 vs. 0.194 ± 0.151, p &lt; 0.05) and significant improvements were observed in each dose increment. CFU-Hill quantification shows the addition of EPC colony in high-dose allicin. Immunohistochemical method shows positive CD34+ expression. CONCLUSION: Allicin increases EPC proliferation dose-dependently from peripheral blood of SCAD patients

Coronary Angiography Characteristics as Predictor of Successful Chronic Total Occlusion Recanalization

Although remarkable progress in percutaneous coronary intervention (PCI) has been achieved over the last decade, the success rate of chronic total occlusion (CTO) recanalization varies greatly. Coronary angiography characteristics may affect the success rate of CTO recanalization. This study sought to establish a scoring model to predict successful CTO recanalization based on coronary angiography characteristics. We analyze 287 angiography data from patients who underwent elective PCI. Angiography characteristics being measured were lesion location, blunt stump, calcification, ostial lesion, bridging collateral, bending, side branch, tortuosity, previous stent attempt, and lesion length of >20 mm. Data were analyzed using SPSS 25.0. Multivariate analysis shows that side branch lesion (p = 0.000), proximal vessels tortuosity (p = 0.015), calcified lesion (p = 0.000), lesion length of >20 mm (p = 0.000), and blunt stump (p = 0.000) can predict the successful PCI in the CTO. ROC curve analysis of the score ability to predict successful PCI in the CTO showed area under curve of 0.89 (confidence interval 95%), the cutoff point of ≤2 with a sensitivity of 93.33%, and specificity of 88.23%. We concluded that the five angiography characteristics that strongly associate with successful PCI in the CTO are calcified lesion, blunt stump, lesion length >20 mm, proximal vessel tortuosity, and side branch lesion. This score may help cardiologists to predict the success probability of PCI in the CTO

Human umbilical cord blood-mesenchymal stem cell-derived secretome in combination with atorvastatin enhances endothelial progenitor cells proliferation and migration [version 1; peer review: awaiting peer review]

Background: Human umbilical cord blood-mesenchymal stem cell (hUCB-MSC)-derived secretome is known to be able to promote neovascularization and angiogenesis, so it is also thought to have a capability to modulate endothelial progenitor cell (EPC) functions. Atorvastatin is the cornerstone of coronary artery disease (CAD) treatment which can enhance EPCs proliferation and migration. This study aims to analyze the effect of the hUCB-MSC-derived secretome and its combination with atorvastatin toward EPCs proliferation and migration. Methods: EPCs were isolated from a CAD patient’s peripheral blood. Cultured EPCs were divided into a control group and treatment group of 2.5 µM atorvastatin, hUCB-MSC-derived secretome (2%, 10%, and 20% concentration) and its combination. EPCs proliferation was evaluated using an MTT cell proliferation assay, and EPC migration was evaluated using a Transwell migration assay kit. Results: This research showed that hUCB-MSC-derived secretomes significantly increase EPC proliferation and migration in a dose-dependent manner. The high concentration of hUCB-MSC-derived secretome were shown to be superior to atorvastatin in inducing EPC proliferation and migration (p<0.001). A combination of the hUCB-MSC-derived secretome and atorvastatin shown to improve EPCs proliferation and migration compared to hUCB-MSC-derived secretome treatment or atorvastatin alone (p<0.001). Conclusions: This study concluded that the hUCB-MSC-derived secretome work synergistically with atorvastatin treatment in improving EPCs proliferation and migration

Interactive Training and Education Improves Basic Hypertension Knowledge of Woman Cadres in Surabaya

BACKGROUND: Hypertension is the major risk factor for cardiovascular disease, a leading cause of premature death and disability. Interactive education and training are potentially used to improve hypertension knowledge. AIM: This study aimed to identify the impact of training and education programs toward knowledge in hypertension for women cadres. METHODS: This quasi-experimental study was conducted in Surabaya, Indonesia, involving 100 women cadre. The data were collected through interviews, pre- and post-training using a validated researcher-made questionnaire of demographic characteristics, and knowledge tests of hypertension. Data were analyzed using SPSS 21. RESULTS: Knowledge of cadre was significantly increased by 50% after the training and education program (p &lt; 0.001). The median score of the pre-test and post-test was 40.00 (30.00–50.00) and 60.00 (50.00–70.00), respectively. The level of education found to have a negative correlation with the post-test score (p = 0.008). There was no difference in knowledge increment after training among age groups (p = 0.261), marital status (p = 0.849), or occupations type (p = 0.827). CONCLUSION: Training and education programs significantly improve the hypertension knowledge of woman cadre. This method can be a preferable early public health intervention to tackle hypertension

Extracellular-Signal Regulated Kinase Signalling Pathway Mediates the Increased Proliferation of EPCs Treated with Garlic (Allium sativum) Extract, Purple Sweet Potato (Ipomoea batatas) Extract and Vitamin C

The endothelial progenitor cell (EPCs) proliferation capability is reduced in the patient with stable coronary artery disease (SCAD). Garlic (Allium sativum), purple sweet potato (Ipomoea batatas), and vitamin C are proven antioxidant which potentially improve EPCs proliferation ability. Objective: To investigate the effect of garlic (Allium sativum), purple sweet potato (Ipomoea batatas), and vitamin C in EPCs proliferation from CAD patients and identify the involvement of Extracellular-Signal Regulated Kinase (ERK) Signalling Pathway. Material and Method: Mononuclear cells were isolated from SCAD patients and cultivated with colony-forming unit (CFU)-Hill medium and divided into untreated (control), garlic extract (10 mcg/ml and 100 mcg/ml), purple sweet potato extract (1 mcg/ml and 25 μg/ml), and vitamin C (10 μg/ml and 250 μg/ml). EPCs proliferation was measured using the MTT Assay. Results: This research shows that EPCs proliferation was increased in the treatment with garlic extract at 10 mcg/ml and 100 mcg/ml dose (0.267 ± 0,003 and 0.391 ± 0.008 ; p < 0.05), purple sweet potato extract at 1 mcg/ml and 25 μg/ml dose (0.250 ± 0.005 and 0.3562 ± 0.023 ; p < 0.001), and vitamin C at 10 μg/ml and 250 μg/ml dose (0.259 ± 0.016 and 0.306 ± 0.022 ; p < 0.001). Increased ERK expression was found in the treatment with garlic extract, purple sweet potato extract and vitamin C. Conclusion: Garlic extract, purple sweet potato extract, and vitamin C can increase EPC proliferation through the ERK signaling pathway

Rosuvastatin is Superior Compared to Simvastatin and Atorvastatin to Induce Endothelial Progenitor Cells Migration

Introduction Statins have shown to improve Endothelial Progenitor Cells (EPCs) function, however no comparison has been done between various statins effectivity to induce EPCs migration. Aim This study compared simvastatin, atorvastatin and rosuvastatin treatment on impaired EPCs from Coronary Artery Disease (CAD) patients. Materials and Methods EPCs were isolated, cultivated and divided into untreated group (control), simvastatin (dose 0.1, 0.25, 0.5 mM), atorvastatin (0.1, 0.25, 0.5 mM), rosuvastatin (0.1, 0.25, 0.5 mM). EPCs migration was evaluated with boyden chamber assay. ANOVA, pearson correlation and linear regression test were done using SPSS 25.0. Results This research showed that simvastatin, atorvastatin, and rosuvastatin increased EPCs migration in dose dependent manner (p<0.05). Regression test showed that simvastatin treatment was responsible for 92.9% of EPCs migration, while atorvastatin was 75.5% and rosuvastatin was 65.6%. Rosuvastatin treatment dose 0.5 mM have the highest EPCs migration effect (195,750.00±5,809.48) compared to simvastatin (123,750.00±9,367.50, p≤0.001) and atorvastatin (156,375.00±12,392.03, p≤0.001) at the same dose. Conclusion Rosuvastatin treatment has higher EPCs migration effect compared to simvastatin and atorvastatin. This suggests that rosuvastatin might be preferable to improve EPCs migration in CAD patients